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DENGUE IGM DETECTION A COST EFFECTIVE ASSAY

ARUNA .

Abstract


Purpose Dengue is an acute febrile illness caused by Dengue virus. IgM antibodies appear early in the course of the disease. The most challenging problem related with patient management in dengue fever is rapid and accurate diagnosis. Our purpose is to compare the diagnostic efficacy of various ELISA kits like, dengue IgM capture ELISA (Panbio) and              Dengue IgM indirect ELISA (Novatec) with reference to dengue IgM capture ELISA (NIV Pune kit).Materials and Methods             Hundred samples collected from clinically suspected cases of dengue fever in tertiary care Hospital were used in this study. Evaluation of dengue diagnostic tests, dengue IgM capture ELISA (NIV Pune kit), the Dengue IgM Capture ELISA (Panbio), Dengue IgM indirect ELISA (Novatec) were done to determine dengue IgM antibodies. Results ELISA by NIV Pune kit ,Panbio and Novatec showed dengue IgM as positive in 54,53 and 52 samples respectively. ELISA by Panbio and Novatec were  compared taking NIV Pune kit as the reference. The estimated specificity was 100 in both Panbio ELISA and Novatec. The sensitivity of Panbio ELISA was 98.14 and that of Novatec ELISA was 96.29 . The positive predictive value was 100 in both. The negative predictive value was 97.87 and 95.83 in Panbio ELISA and Novatec ELISA respectively.Conclusions The present study established that both panbio, and Novatec ELISA tests were of almost equal efficacy with accuracy of 99 and 98 respectively. Since ELISA by Novatec is of lower cost and took lesser time to perform it is preferable.


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Resubmission of the scientific paper based on the suggestions given by the reviewer;

Question;kindly clarify whether NS1 antigen was used as a parameter for diagnosing dengue

cases.

Answer: NS1 antigen is an important diagnostic tool. But detection of NS1 antigen was not done due

to nonavailability of NS1 ELISA kit in our hospital during the period of study (April to June).

Question; Platelet count comes down drastically in secondary dengue infection. Presence of IgM usually denotes primary dengue infection. Usually platelet counts may not be that low in such cases.

Answer: Platelet count becomes very low in secondary infection.In primary infection also platelet count is low but not as much in secondary infection.As presence of dengue IgM usually denotes primary infection, it was used as a diagnostic tool for detecting dengue IgM.The study doesnot

differentiate between primary and secondary infection as NS1 antigen ELISA and dengue IgG ELISA kits were not available in our hospital at the time of study.

Question; What was the co-relation of platelet count versus IgM positivity in your study.

Answer: In the present study, out of 54 positive cases of dengue IgM, 19 fever cases had platelet count less than 40,000/mm3.Platelet count was between 40,000/mm3 and 80,000/mm3 in 31 cases. In four cases platelet count was between 80,000/mm3 to 1, 00,000/ mm3.

Question;Can dengue infection be ruled out in case of IgM negativity - please explain.

Answer: Dengue infection cannot be ruled out in case of IgM negativity without detecting NS1 antigen and dengue IgG.

NS1 antigen is detectable from the first day of fever. IgM antibody response to dengue virus appears 5-7 days after the onset of illness in primary dengue infection. It persists for 2-3 months. In secondary infection IgG antibodies are produced in high levels with the weak IgM antibody response

after third day of fever. So, dengue IgM alone, without NS1 antigen detection, cannot confirm dengue infection. Likewise to rule out secondary infection dengue IgG has to be detected along with dengue IgM. Therefore no single diagnostic assay in isolation is adequate to diagnose dengue infection


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